| NPI | 1831576669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 372185-4405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 372185-4405) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2024-04-11 |